Healthcare Provider Details

I. General information

NPI: 1699688671
Provider Name (Legal Business Name): DAUDA KEMOH KOROMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 ROSEBUD RD APT 412
LOGANVILLE GA
30052-3070
US

IV. Provider business mailing address

2935 ROSEBUD RD APT 412
LOGANVILLE GA
30052-3070
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-2029
  • Fax: 770-339-3375
Mailing address:
  • Phone: 770-339-2029
  • Fax: 770-339-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036534
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: